Ovarian cancer is diagnosed too late. A British team lays the foundation stones for a future mass screening.
The “silent killer”. The nickname of ovarian cancer says a lot about the prognosis of this pathology. Certainly, with 4,000 new cases per year, it only ranks fifth among female cancers. But this “rare” cancer still kills 3,500 women each year. This massacre has an explanation, late diagnosis. Some 70% of ovarian cancers are detected at stage 3. And there, the 5-year survival rate fluctuates between 5 and 25%. If it were diagnosed at stage 1, 90% of patients could be saved. Suddenly, the interest of early detection is not to be demonstrated. This is why Professor Ian Jacobs’ British team has been working there for 25 years. And the preliminary results of their latest study published in Lancet Oncology, suggest that they are approaching the goal. Concretely, Professor Jacobs launched a large study among 200,000 women in order to compare two screening techniques: the first combines the monitoring of a biological marker (the CA 125) interpreted using a risk score, followed by a transvaginal ultrasound for women with an abnormality. The second technique is based only on an examination: ultrasound. Results: the combination of the two examinations made it possible to detect most of the women developing cancer and in half of the cases, at the very first stage. This double technique presents another advantage, that of dividing by nine the number of surgeries per cancer detected.
Screening in ten years
“We are really on the right track,” rejoices Professor Eric Pujade-Lauraine, oncologist at Hôtel-Dieu. But we still need to improve sensitivity. Indeed, out of 97 women who underwent surgery, 42 actually suffered from cancer. “We cannot accept such a ratio,” said Professor Pujade-Lauraine. Unnecessary interventions should be reduced to around 20% ”. Mass screening is therefore not for now. “We will have to wait another ten years,” forecasts the oncologist from Hôtel-Dieu. This is also the opinion of Professor Jacques Dauplat, head of the surgery-oncology department of the Jean Perrin center in Clermont-Ferrand. The technical nature of screening but also its economic impact make it inaccessible for the moment. “In addition, before setting up screening, recalls Professor Dauplat, we must prove that it reduces mortality. The British study does not yet provide this proof ”. Prof. Christophe Tournigand, medical oncologist at Saint-Antoine hospital, is much more skeptical. On the one hand, because “the benefit of mass screening for such a rare cancer will not be easy to demonstrate”, and on the other hand, because “the CA 125 is not a very reliable indicator. . A common ovarian cyst can cause it to increase ”.
However, some specialists believe that these promising results may have immediate use. “I think that this early detection should be developed with a population at risk. In my opinion, this would be an interesting alternative to prevention by ovarectomy, ”suggests Professor Pujade-Lauraine. For all the other women, we will have to wait a little longer. “Biological microdosing techniques should be developed in order to identify precursor signs of the disease,” suggests Professor Dauplat. But here we are still only at the basic research stage. Ovarian cancer is therefore likely to remain silent for many years to come.
Questions to Prof. Jacques Dauplat, head of the surgery-oncology department of the Jean Perrin center (Clermont-Ferrand)
Too heavy an economic impact
Does the British study show that screening for ovarian cancer is feasible? Pr Jacques Dauplat It’s a very interesting study, but it seems premature to consider mass screening. She compares a screening technique that is multimodal, involving several tests, to a simple ultrasound test. And we can see that the method combining several exams is more efficient. One of these exams is the regular dosage of CA 125, which is a biological marker, interpreted according to a risk algorithm. This requires considerable interpretation and experience that we do not yet have in France today. It would be necessary to know if this algorithm is directly transposable.
Is systematic screening economically feasible? Prof JD It is indeed an obstacle and not the least. Because, as the study of Ian Jacobs shows, when an ultrasound test is necessary, it is carried out, in Great Britain, by technicians, which they call sonographers. However, in France, we are not at all in this perspective. Ultrasounds should be performed by doctors. This assumes that they are available, trained. The economic impact of any screening would therefore not be the same at all.